Humanising the migration crisis

Survival migrationⁱⁱ and population displacement are challenges that will worsen in coming years due to climate change, conflict, and economic crises. The United Nations state that one in 8 of all people across the world are on the move – an estimated 1 billion people. Of this population, one in 10 (100 million people by end of May 2022) have been displaced due to armed conflict and climate change.ⁱⁱⁱ Practical policy ideas based on evidence, and which treat people humanely are now needed to tackle these systemic challenges.

A new report from the Research for Health in Conflict Group led by academics from the Centre for Business Research at the University of Cambridge and colleagues from King’s College London and the American University of Beirut presents stark insights into the treatment of refugees and asylum seekers in the UK, especially their mental health.

Lead investigator Professor Simon Deakin stated that “the report provides a hard reflection on the sobering reality of the mental health of migrants and refugees in the UK. There is a crisis of compassion that requires urgent public policy intervention.”

Lead investigator Professor Simon Deakin stated that “the report provides a hard reflection on the sobering reality of the mental health of migrants and refugees in the UK. There is a crisis of compassion that requires urgent public policy intervention.”

The report, based on insights and field experience from frontline staff and representatives from the NHS, United Nations and on-the-ground International Non-Governmental Organisations, shows how the ongoing asylum crisis has exposed the fragility of frontline mental health and public services as well as the double standards which have been applied in the treatment of displaced people from the Ukraine and those from the Middle East.

Professor Hanna Kienzler from King’s College London commented that “the current asylum system has detrimental effects on sanctuary seekers’ mental health. Difficult to navigate and lengthy legal procedures to claim asylum and substandard living conditions cause great distress. Data for England shows, for example, asylum seekers are five times more likely to have mental health needs than the general population while available services are difficult to access due to fragmentation, language barriers and lack of cultural humility.”

Home Office data shows that of all refugees resettled in the UK from January 2010 to December 2021, around 70% were Syrian citizens. “31,101 refugees were resettled in the UK under its 6 different resettlement schemes.^iv Most were nationals of Syria: 68%.” In March 2022 the UK Home Office confirmed that 25,500 visas had been issued to Ukrainians since the war began, while the UK resettled only 20,000 Syrian refugees over the last 6 years.^v

Mental health of newly arrived and local populations

Refugees traumatised after being in conflict zones, the journey across Europe and the protracted asylum process struggle to find support for their mental health needs. The ‘left behind’ local populations in deprived areas of England fare no better, facing lengthy waiting times for access to local mental health services. The perception that locals and asylum seekers will compete for the same services albeit to the detriment of local populations is fuelled by polemical political statements that generate feelings of them and us. However, the evidence for this does not exist.

Frontline public services in the UK are operating under severe resource constraints. Mental health services are stretched and under-resourced despite increased investment. NHS Digital and a National Audit Office report shows that 1.4 million people are waiting for treatment^vi with 8 million people with mental health needs not in contact with NHS services. A recent Department for Health and Social Care (DHSC) report states that “there is a gap in the literature regarding UK-wide assessment of access and delivery of mental healthcare for asylum seekers and refugees in the UK.”^vii

The politicisation of migration and asylum in Global Britain

Where an appropriate and human rights-based policy response is needed, it is replaced by public anger and fear. Vulnerable groups have become ‘stuck in legal limbo’, politicised by the Illegal Immigration Act^viii and the policy mantra of ‘stop the boats’.^ix A leading think tank, the Institute of Government, has pointed to the growing use of political rhetoric in place of coherent policy towards refugees and asylum seekers.^x

‘Global Britain’ is perceived as a stable and welcoming country adhering to the rule of law; one in which people can get on and better their lives and that of their families. Yet insights provided by frontline NHS, UN, NGO staff and refugees at a one-day workshop held at the Royal Society of Medicine suggest otherwise with thousands stuck in the asylum system facing daily discrimination, a range of severe mental health conditions, a lack of access to basic services, and prevented from working. This poses significant challenges for public health, social cohesion and security, as well as creating future fiscal burdens on health and social services.

Policy options: the need for evidence and human centred policy design

The report authors offer a portfolio of evidence-based practical policy options and research recommendations to tackle mental health and public service issues facing both local UK populations and asylum seekers. These include:

• ensure equitable service access and delivery for RAS and local populations at-risk;
• fiscal ‘win-win’ of employing displaced medics and nurses in the NHS by reducing the time needed to register with the General Medical Council^{xi xii}
• strengthening cooperation and interoperability between departments working in the field of foreign policy and development – FCDO to the domestic such as the Home Office and DWP
• enhancing the training of NHS staff to deal with severely traumatised refugees
• trialling of an electronic health information passport
• creation of local schemes and programmes under the Levelling Up Agenda to get locals and refugees to interact and ‘rub along’ with each other, thereby breaking down and challenging media borne stereotypes. Local food sanctuaries as tested in the United States may appear naïve but current evidence suggests they work to break down cultural barriers and discrimination

The authors also highlight that mental health issues experienced by refugees in the UK could become a security concern. A developing body of research offers credible insights into the links between mental ill health, extremism and radicalisation.^xiii

The economic ‘win win’ case

Dr Adam Coutts from the University of Cambridge, one of the report authors, commented that “the situation has become so politicised that common sense analysis and practical policy options from across the political spectrum don’t feature. Even the rational ‘no brainer’ economic ones which show that asylum seekers can pay for themselves and make significant contributions to the UK economy and labour market are absent.”

Recent research found that allowing people seeking asylum the right-to-work would increase tax revenue by £1.3 billion, reduce Government expenditure by £6.7 billion, increase GDP by £1.6 billion, and improve the mental health and wellbeing of those individuals.^xiv Current political arguments that asylum seekers cost 6 million pounds per day in terms of accommodation needs miss the point that these costs could easily be offset by respecting migrants’ right-to-work.^xv

Professor Richard Sullivan, a leading Oncology surgeon and report author from King’s College London comments “We know what works in how to get displaced professionals integrated and employed in the NHS. The framework is already set up – the medical support worker model. Problem is that politicians won’t touch it for fear of losing votes. We have hundreds, potentially thousands of displaced professional people (medics and nurses) stuck in the asylum maze. This political sclerosis is making our jobs in the NHS even harder and costing lives because there are not enough staff to cope with the demands.”

The report shows how we treat the most vulnerable, both those newly arrived and locals, is understood beyond the UK to reveal a great deal about the level of care and importance to which policy and politicians pay to those who most need our help. Perceptions of how debased policy and the media narrative have become in modern Britain are now commonplace abroad, limiting the scope for meaningful cooperation with our international partners.

James Watt, the former UK ambassador to Lebanon, Egypt and Jordan, adds “the genuine compassion for refugees shown in much of society is set against the chilling ‘hostile environment’ policy put in place by the current government. The hardening of the policy, in the face of its failure to achieve its deterrent purpose, has compounded its harmful effects on human lives. The harm inflicted on individuals will go on to damage the social cohesion of UK communities and families, for lifetimes.”